Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Policy News 

unhappy doctor with headache stressed holding coffee.jpg

The Trump Administration will continue to use a bundled payment model for Medicare recipients. This means that the government will pay a certain lump some to cover all the inpatient and procedure related medical care given to Medicare patient rendered in a 90 day period of time. If the healthcare providers use less than that amount of money they can receive a bonus. This strikes me as a terribly perverse incentive. Hospitals and caregivers have every incentive to skimp on care so they can pocket the bonus. What if the amount of money allocated is not enough for all the care the patient needs within the 90 days? It is interesting to note that this bundled payment strategy was created under Obamacare (The Affordable Care Act or the ACA) and has been reincarnated in almost exactly the same form under the Trump administration.

Several women’s health organizations including the American College of Obstetricians and Gynecologists (ACOG), have instituted a program called"The Care Women Deserve”. Under this program, there will be an effort to educate all women regarding the health services to which, under the ACA which is current law, they are entitled, at little or no cost. Examples of these services include well woman visits, also known as annual exams, Pap smears, contraception, also known as birth control, HIV screening, mammograms and breast-feeding support. Not all women know that they are entitled to all these services.

The Trump administration has long tried to weaken the contraceptive mandate, the part of the Affordable Care Act which requires insurance companies to cover contraception without co-pay. They have received many legal challenges to these attempts. The Trump administration has paid out over 3 million dollars of taxpayer money to to settle these lawsuits.

For the first time in Medicaid's 50 year history certain states will be allowed to interpose work requirements on certain able bodied adult recipients. The National Health Law Center is preparing to challenge this in court.

Washington DC’s only pubic hospital has been closed due to quality concerns. 

The Wall Street Journal is reporting that the GOP is scaling back plans to reform the ACA and social security type programs. They are focusing on basic problems like funding the government. They are even talking about increasing the debt limit and reaching a compromise on immigration. Since when has the GOP been interested in increasing the debt limit ? 


Medical News 


  • Once again our own immune system is at the heart of a disease process. Evidence from a mice model suggests that the damage caused from Zika virus infection is actually from the mother’s immune response against the virus in the baby. This was published in Science Immunology. 
  • A large retrospective study has indicated that pregnant women who take methylphenidate for ADHD have a higher likelihood of having a baby with a heart defect. 
  •  A new study published in the Journal Birth looks again at Texas maternal mortality rates. Between 2011 and 2015, there has been an 87% spoke in maternal mortality. The worst has been in mothers over, 40 with that group having a mortality rate 27 times that of women under 40. This is felt to be related to increasing rates on chronic and under treated disease including obesity, lack of insurance and lack of health care. 
  • A 172 woman study published in Menopause made the we-already-knew-this-department. They have shown that one year of postmenopausal hormone therapy prevented depressive symptoms more effectively than placebo. Postmenopausal hormone therapy is FDA approved for hot flashes and vaginal dryness, but not for mood disturbance. Maybe it should be. 
  • The Journal of Asthma has published a study linking prenatal exposure to PCBs ( polychlorinated biphenyls) to asthma and upper respiratory infections and eczema in children. 
  • A new study has indicated that women who work night shifts have a (gasp) 19% higher chance of getting cancer than those who do not work at night. This meta-analysis has shown that the risk is proportional to time worked at night, and that the risks  go up differently for different cancers. The most surprising is skin cancer with a 41% increase in risk. Next is a 32% increase in breast cancer, and an 18% increased risk in digestive cancers. Yikes ! I hope the exact reasons for this get figured out and dealt with ! 

We have a new department ! It is called the stupid and irresponsible department. Our inaugural feature is devoted to the TV show Black Mirror, whose writers decided to depict emergency contraction, aka “ Plan B” or “ the morning after pill” quite incorrectly. In particular, they portrayed a teen who took it as having nausea, which is not typical. A nurse in the show informs her she had taken it “ to terminate a pregnancy”. Basically the show confused the morning after pill with the abortion pill. The morning after pill is progesterone only, thus should not cause nausea. Plan B does not cause abortion of an established pregnancy. It prevents pregnancy. Thanks so much, TV,  thanks. 

Stay tuned for more exciting news from the world of Obstetrics and Gynecology next week here, on Medical Monday. 


Wellness Wednesday: Help for the Elves

Are you that truly time strapped gift giver with the finite budget ? Have you been reading all that advice about scaling back this holiday ? Are you tired of the materialistic holidays, the stress, and the excessive spending ? Here is some SMART advice to help you through. SMART means specific, measurable, attainable, relevant and time bound. Instead of saying, I’m going to do better this year, have a SMART plan for getting your tougher gifts done. 

They say the best things in life aren’t things. Here are some: 

Home made paper or gift certificates for activities with YOU ! Examples: 

  • a movie
  • lunch out or lunch in 
  • a hike in the outdoors 
  • spa day 
  • craft day 
  • joint workouts 

Here’s athoughtful gift for that person who has enough “stuff” : A donation to their favorite charity, cause or advocacy group, (usually able to be made online). You can send a card or a decorated email to announce the gift. 

For those who would like to give, but are perhaps late on mailing things to faraway relatives, ebooks and audiobooks come to the rescue. You can send an inexpensive but special ebook instantly even on Christmas eve and be right on time. is my go-to for the instant gifts. Your recipient can read them on any device, not just a Kindle. Kindle apps are available on virtually all platforms including the desktops PCs and Macs, as well as Android and IOS. Your gift can combine an ebook and an experience if you gift the book and buy one for yourself, then propose that you and even a faraway friend can read it “ together”. is my source for ebooks since I am a member. This service is certainly worth looking into, especially if you ever have long commutes, flights, or road trips. 

For an even more economical gift, you can send music, even just one song, or an app, as a gift. These too are electronic, and thus accomplished at your desk in the wink of an eye. 

It’ s the small things that count. So send valuable information ! Most of us have a recipe or two that is special to others. Write it up with nice paper or digitally with graphics, and send the recipe or a collection of them as a gift. 

Other small things include thumb drives - perhaps one filled with your best photos of activities you and your recipient have shared. Tie it with a ribbon or some twine and you have a very easy, very economical and very special gift. 

Making celebrations and gift giving is fun but can be overwhelming. Get inspired, and stretch a little, but do not stress or worry yourself. That would be missing the forest for the Christmas trees ! 

Enjoy these last few days before Christmas ! 

Wellness Wednesday: Travel Insights

I am in black and with me is Kyra Bobinet, MD, MPH of

I am in black and with me is Kyra Bobinet, MD, MPH of

Although travel is often arduous, it has the capability to be really invigorating. Travel is meant to refresh both the body and the spirit. 

I travel seldom. Often, when I do, it is for a specific reason such as a conference. Nonetheless, it gives me perspective on the destination and on home. I also learn things about myself. Here is a sampling of my insights from a recent trip to Stanford Medx. 

  • I worry before a trip and invariably come to find that my worries were largely unfounded.
  • Every time I travel, especially the day I’m supposed to depart, I'm reluctant to leave home and have strong feelings of missing home. However, by the time I change planes, I am very glad I went and I get excited for the destination. Toward the end of the trip, I'm anxious to depart, and love arriving at home.
  • I romanticize my destinations yet ultimately find that they, like all places, have advantages and disadvantages.
  • I sleep more when I am not at home since I do not engage in the endless list of things to do at home.
  • I feel better when I sleep more as many people have told me I would.
  • I am becoming increasingly selective about what I eat.  I am therefore becoming more careful about bringing food, especially snack foods, with me.
  • I am more determined than before about finding new ways to keep up on my workout while I travel.
  • I drink more and hydrate better when I am away and I feel better because of it.
  • I am still reserved at the beginning of a big interactive conference. I then realize partway through the conference that there is no reason not to approach anybody, including the main speaker, that I find interesting. When I do approach people with reasonable points or questions, they are uniformly receptive and share generously.
  • I never bring enough business cards. And in a related vein, my business cards are boring. I need some new ones.
  • I sometimes get the “ I am not worthy“ feeing when I meet people of towering brilliance and accomplishment. It does not take me too long to realize that this is a waste of energy. However, it still happens. Thankfully, this feeling does not paralyze me, and it makes me want to do more. These negative feelings are eclipsed by my gratefulness at getting to meet such people.
  • I am afraid of “ losing” the cool people I meet on my trips, so I have become more thorough about getting their complete contact information, often including pictures. The funny thing is, everyone else seems to be doing the same thing.
  • I used to disdain Twitter, but now I get it. I don’t know if this was one of the original intended uses, but I quickly learned to do as others were doing and tweet out key points from the lectures, including helpful hashtags and relevant twitter handles. The twitter stream from the sometimes concurrent presentations in one conference could thus be shared by all who were interested, regardless of what presentation they attended or, regardless of whether they were present at the conference at all. I was enthralled by the idea that we were creating a crowdsourced collective impression of the conference available live in the twitter sphere.
  • When I travel to places where I have lived before, I feel a pleasant sense of continuity from past to the present. I also get a sense of longevity, as though life is reasonably long, and that you are free to do many different things over the decades.

Traveling inspires me to do more and be more. It makes me appreciate both home and the destination better. If I go back in time by going back to a place I’ve lived before, I gain understanding and compassion for my younger self.

Traveling can be expensive and challenging to arrange. However, I believe that it is worth it.


Here are some older posts I wrote about travel: 

Travel Wellness

Travel Food

The Structure of Travel




Medical Monday: Breaking News from the World of Obstetrics and Gynecology 

About 1.6 million pregnant women are at risk for Zika virus infection in South and Central  America. Now, health officials are concerned that local transmission of Zika virus has begun in southern Florida. This means the virus was acquired in Florida, instead of being acquired elsewhere while a person was traveling. This means that some of the mosquitos in Florida carry the virus.

In related news, the blood supply in South Florida is now considered to be potentially contaminated with Zika virus. The FDA ( Food and Drug Administration) has asked that all blood donations from South Florida halt until all donations can be screened for Zika virus.

In even more striking news, the CDC ( Centers for Disease Control)  is recommending that all pregnant women be screening for the Zika virus. 

As most of you know, Congress left for its seven week vacation without coming to an agreement on Zika funding. The President of the American College of Obstetricians and Gynecologists has written a strongly worded letter to Congress on this matter.

Proceedings from the National Academy of Sciences include research that indicates that women who enter menopause early age faster than other women. They were able to quantify this, saying that menopause speeds up cellular again about 6 %. They also indicated that poor sleep can trigger similar aging type changes. 

In related news, women who start menstruation late and who have menopause late compared to average are more likely to achieve 90 years of age. Information like this is useful in that it helps identify factors tied to longevity. 

Research from the Journal Circulation has indicate that only 2.5 hours of moderate exercise per week has measurable effects on heart disease risk in women. Let’s see, taking one day off per week leave six days for exercise. Divide that into 2.5 hours to get the time per day needed for exercise. Only 25 minutes per day needed to reduce cardiac risk ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn and women’s health.

Wellness Wednesday: Sleep Hygiene with Sketches

It is summer in the far north and the days are long they stretch into the night. Farmers work until 11 pm and dinner is at about 9pm in broad daylight. Then the evening comes, and by 11 pm you feel the evening is just getting started. A movie is chosen and whoops, you are up way too late, especially since the sun comes blazing in shortly after 5:30am. 

So I though I would take this opportunity to share with you some sketches I did for my wellness reminder cards that pertained to the importance of good sleep hygiene. Each card will hopefully remind the user of a key principle, with the image on one side, and the reminder on the other. 

1. Adequate Restorative Sleep 

With few exceptions, adults need 7-8 hours of sleep. You should wake, almost spontaneously, and feel rested. That is the meaning of restorative sleep. 



2. Consistent Wake Time

Having a consistent wake time actually helps you fall asleep properly at bedtime. 





3. Consistent Sleep Time

Once you get in a routine, you will start to get sleepy at the right time. 





4. Correct Sleep Environment

The room should be dark, quiet and cool, without electronics or snoring people. 






5. Medical Evaluation of Necessary

Most major hospitals have a Sleep Center or Department of Sleep Medicine. There is now the recognition that sleep health underscores all health. Rigorous studies can be done to assess sleep problems, and treatments are available. 



To learn more see our webpage on sleep HERE

Next week on wellness Wednesday we will continue with more wellness reminders. 

Nighty Night !



Wellness Wednesday: Healthy Habit Formation 

Healthy habits are the basis of peak wellness. Heathy habits are something we can develop. Whether the healthy habit is taking vitamins, being grateful, exercising, or eating fiber, the practice only works if it is done over and over for extended periods of time. This repetition is achieved through habit formation. 

What does science say about how habits are developed ? 

The brain is designed to form habits.  New behaviors or tasks can be challenging. Over time, the brain “chunks” small possibly difficult behaviors into automatic routines which becomes easy or even effortless. This is a habit. Habits are adaptive and have helped us survive. Habit formation is our brain’s way of automating certain key behaviors, so more conscious attention can be paid to novel situations.  If we understand how this works we can form new habits at will. 

What do we need to form new habits ? 

In simple terms there are three steps: 

  1. Cue
  2. Routine
  3. Reward

This is called a habit loop. These are well explained in Charle’s Duhigg’s book "The Power of Habit”.  The cue triggers the routine, and the routine triggers anticipation of the reward. For example, my exercise routine is cued by changing into exercise clothes. From there, I go downstairs to workout, and the reward is the endorphins and the satisfaction. There is no doubt that at first, it is hard to link the steps. But it becomes easier with each cycle. To be realistic, it takes somewhere between 6 weeks and 3 months to form a new habit. 

What about bad habits ? They too have cues, routines and rewards. Basically, they have to be understood in terms of their rewards, namely, what you get out of it. In many cases, smokers smoke to get a moment of peace in a busy day. This is obviously legitimate. However, the cigarette is unhealthy and chemically addictive in addition to being behaviorally addictive. It turns out we should not exactly delete bad habits since this leaves a void. Instead we are better off to overwrite them with good ones. To illustrate, a smoker could use patches to wean down on the addictive nicotine, while overwriting her smoking habit with a healthful tea drinking habit. Perhaps to make it more engaging, she would brew the tea from loose leaves. Her reward would be the moment of peace, the taste, smell, and mental clarity that followed. 

My subject in this post are the cues. In simple terms, they are reminders of health habits. I decided to expand my set of reminder cards to include not only the subject of nutrition, but also the subjects of sleep, exercise, communication, and creativity. I believe these are some of the elements in total peak wellness. Here are my cue phrases so far. 


  •      Adequate restorative sleep 
  •      Consistent wake time 
  •      Consistent sleep time 
  •      Correct sleep environment 
  •      Medical evaluation if necessary 


  •      Start easy and short 
  •      Warm up
  •      Cool down 
  •      Value initiation over endurance 
  •      Good gear 
  •      Eat for exercise 
  •      Hydrate for exercise 
  •      Tunes for exercise 
  •      Podcasts for exercise 
  •      Exercise daily 
  •      One break day per week 
  •      Stretch after exercise 
  •      Buddy exercise 
  •      Track your exercise 
  •      Explore HIT 
  •      Include yoga 
  •      Mix it up 
  •      Use good form 
  •      Consult professionals 


  •      Get inspired through people travel and media 
  •      Find your styles 
  •      Express creativity in your personal space 
  •      Make a space for your creativity
  •      Take time for hobbies 
  •      Take time for Travel
  •      Take time for recreational reading 
  •      Pick a hobby and learn it well
  •      Share your creative work


  •      Always work
  •      Honor work in and out of the home 
  •      Chose meaningful work 
  •      Become expert at your work
  •      Give work boundaries in time, space, and thought
  •      Do you best at work 
  •      Communicate effectively at work
  •      Reach out often at work
  •      Play as a team 
  •      Ask for appropriate compensation


  •      Breathe and think before speaking 
  •      Use Honesty 
  •      Use courtesy
  •      I statements
  •      Precision of speech
  •      Closed loop communication
  •      Listen more than speak 
  •      Listen actively
  •      Repeat back clarification 
  •      Acknowledge others’ point of view
  •      Build common ground


You can find nutrition reminders HERE discussed in a prior post. I plan to devote a few wellness Wednesday’s to the development of these reminders or cues. 

For more reading :

Wellness Wednesday: How to Tell if You’re a Workaholic

Most people say they are busy. But are they ? Americans are famous for being workaholics (fully 25 % of us). How busy is too busy ? 

I would like to present my thoughts on the issue. Then I would like to present some other sources which are more authoritative.

It is important to understand what is not too busy. If you work full time, but have no time to work out or see your spouse, and yet you have time to game, watch TV or get a professional pedicure, you are not too busy. 

You are not too busy if you find that working at your desk leads to hours of randomly surfing the web or checking social media. You can only assess yourself once you have cut all the unintended time wasting from your life. If you are mindfully watching a film, or checking specific things in social media for a few minutes, that is fine and does not count as time wasting. 

So let’s say you have optimized the way you work and spend your time (a topic for another day). Let’s say you have reviewed your schedule and have decided that everything on it is important and nothing can be cut. Then you have met the “ inclusion criteria” and can ask yourself these questions: 

  • Am I getting less than 7 hours of sleep on a regular basis ? 
  • Do I feel a constant sense of frustration at not getting things done ? 
  • Do I lack time to work out for 30 minutes per day ? 
  • Do I lack time to eat three healthy meals and snacks ? 
  • Am I getting sick too often ? 
  • Is the quality of my work getting lower and lower ? 
  • Am I neglecting important relationships ? 


If you met the inclusion criteria and you answered yes to any of these things, you should consider thinking about whether you are overcommitted. These would be the relevant endpoints for me, after 54 years of living with, working with and being an overcommitted person. 


This article places workaholism in its psychiatric context. It is a compulsion to go work, combined with discomfort when not working. So it is much more than working hard, or working a lot. They site signs like trouble delegating, thinking about work while on vacation, or neglecting one’s nonworking life. They indicate that cognitive behavioral therapy and support groups can be helpful. 


This feature described signs you might be a workaholic. Noteworthy signs including having no hobbies, working through lunch every day, coming to work when sick, being accessible to work all the time, and consistently overbooking. 

The WORKAHOLICS ANONYMOUS site is a real eye opener.

Surprises in their list of 20 questions include "Do you regularly underestimate how long something will take the rush to complete it ?” This is a more in depth read and I recommend it. 


Forbes showcases a very worthy article about work-life balance, citing some interesting statistics including the following : "Americans put in more hours than workers in other wealthy countries and are more likely to work nights and weekends.” They alsogive an introduction to Bryan Robinson’s book “ Chained to the Desk”, which is available on Amazon. 

The follow up articles in the same series

details 6 tips for a better work like balance. The two tops which appeal to me the most are “ Letting go of perfectionism” and “ Limit time wasting activities and people”. 


This site highlights some more surprising aspects of workaholism including the observation that workaholics lose track of time. They also highlight some chilling aspects of workaholism including the problem in Japan, where early death related to workaholism has its own word, karoshi. We all know that workaholism takes a huge toll on mental and physical health, but death by karoshi is hard to fathom. 

I am going to strive in the next few weeks to make my posts more brief. I will feature more outside sources. It is my hope that these posts will be easier to write and easier to read. This is one step I will be taking toward a better work like balance. 

Send me your thoughts on the matter. I would love to see what you think. 







Wellness Wednesday: Healthy Stuff 

Wellness includes how you feel as you function in everyday life. How you function greatly influences how well you are. How you handle your material belongings in your home and workspace influences all of this. Today’s post is devoted to introducing the topic of  healthy relationship with your material belongings. 

The developed world has an unhealthy relationship with stuff. Many of us have more than we need. Our collective patterns of consumption strain the environment.  Our individual patterns of consumption strain our personal finances. Excessive objects clutter our spaces andmakes us miserable. 

How can all this be stopped ? Two fairly recent books have addressed this challenge. The first was written by two friends of mine, Joshua Millburn and Ryan Nicodemus. It is titled, “Everything that Remains”.  I met these two fine fellows at TEDxWhitefish where they gave a beautiful and clever presentation on Minimalism, or the art of mindfully curating one’s things and one's life down to that which is necessary and desirable. You can access their work HERE:

and their TEDx HERE:

The second is a really trendy and fascinating set of books by a Japanese women named Marie Kondo. She has written The Lifechanging Magic of Tidying Up and its companion volume, Spark Joy. These books go into the concrete details of tidying up. However it is not done for its own sake. She makes it clear that it is to enhance quality of life and effectiveness in life. Ms. Kondo draws a clear connection from this tidying practice to clarity of mind and clarity of purpose. She speaks of improving relationships and clarifying life goals as by products of removing one’s clutter, and systematically determining which of one’s possessions “ spark’s joy”. Sparking joy is, in fact, her inclusion criteria. One should only keep an item if it “ sparks joy". Granted, joy is broadly defined to include traits like beauty or utility. She states quite plainly that curating and decluttering your space is a prerequisite to clarifying what is one’s own unique ideal lifestyle. 

I am no minimalist. In fact I derive great joy from textiles, colors, and various materials. I continually acquire new books. But I have come to understand that I should go through my things periodically, and that if I do there will be things which I can let go. Thus the quality of my items increases as their quantity decreases. 

I have also come to utilize alternatives to “ things”  more often. In particular, I am a magazine addict. My office overflows with them. I do not like the piles, even though I derive great joy from the individual issues. My solution ? I have gotten an app called Textile. For a small subscription fee, I can get many of the magazines I want in digital form. Additionally, I consume more and more material by Kindle or Audible. There are still some things, like cookbooks, which I like to have in paper, but this is the case less and less. 

I am interested in gaining mastery over my things so they are not master of me. I would like to edit and organize my things so they do not take up so much of my time. I am beginning to see time as a more tangible commodity. I am becoming more and more selective about how I spend this “ thing” called time. Your material possessions, you time, your lifestyle choices and your wellness are intimately related. Check out these two books, their insightful authors, and give a little more thought to how the space you inhabit influences the life you live. 


Wellness Wednesday: Healthy Architecture

Have you you ever noticed that you just feel good in some homes ? This might be because of the people who live there, or because of some happy memories. Or it could be the architecture ! It has been definitively shown that architecture influences our health and our sense of well being. In this post we will be examining what science and architecture say about healthy living space. 

Vitruvius, a famed architect and engineer of the Roman Empire, note that three elements were required for a well designed building: health, comfort and delight.

Cleary these requirements go beyond household air and water quality, lighting, waste management, and nontoxic materials. They go beyond shelter, privacy and safety as well. 

The AIA or American Institute of Architects has utilized a set of design principles to inform architecture not only for homes, but for schools and hospitals as well. They are as follows: 

  • Safety
  • Social Connectedness 
  • Environmental Quality
  • Sensory Environments
  • Physical Activity
  • Access to Natural Systems. 

This means that besides being safe, homes need to provide a space for people to comfortably gather. They need to be designed in such a way as to foster good air and water quality in the home. They need to provide pleasant sensory experiences of sound, sight, smell and touch. They need to foster the ability to be active. Finally they need to include or be able to interface with nature. 

According to Robert Ivy, CEO of AIA, these criteria for health fostering architecture can go even further. He highlights the following design principles: 

  • Biophilia
  • Educational design strategies 
  • Light as therapy

Biophilia refers to our innate love of nature. It even alludes to the fact that exposure to the natural world has measurable effects on well being. This can mean we keep indoor plants. It could also mean we keep a small garden outside the kitchen door. Educational design, means that our physical spaces ideally foster learning. This may mean something as simple as including space for an aquarium,. Or, it may mean including bookshelves, a tool shop, or a lego table in a child’s room. Light as therapy is a proven factor. Daylight fosters recovery in the hospital and good emotions at home. Daylight is ideally part of every room in a building. 

Designing for wellness is important whether you rent, own or are building your home. Small but well informed changes in your living space can have significant effects on wellness. 

To learn more:






Wellness Wednesday: Time and Goals

We each have goals. What would it be like to accomplish them ? What would it be like to accomplish a lot of them ? Some people do. These are people with good time management. 

It occurred to me that before I discuss exercise on this Wellness Wednesday blog, I should discuss the one thing my patients say they need before they can exercise: more time. We all have one lifetime of time. What matters is how we use it. Everyone knows this, so what is the problem ? 

Most people are not fully aware of how they spend their own time.

They are not as factually familiar with how they spend each hour as the think they are. I have found that everyone thinks they’re busy, and everyone thinks they're active. People are less sure if they are efficient in their day. This is the territory I suggest we explore at this point in the New Year. 

We are talking about time management. Have you ever had a class in this ? Few people have. It seems like it would be a good idea right at the beginning of high school. Or how about right now, in the blog post ? 

Here is your mini class on time management, complete with some handouts and homework. 

  • Obtain a notebook to document this process. 
  • Record your present schedule, down to the hour, for one week. Include everything from housework to Facebook. Wear a watch all week so you will have realistic estimates of time. 
  • Make a list of goals, for the week, month, quarter, year and five years. 
  • Order the goals by priority.
  • Assess your week long log and see where you are misdirecting or wasting your time. 
  • Realign your schedule with your priorities. Include a spot for 30 minutes of exercise 6 days per week. 
  • Record what happens the next week and repeat. 

Now this is a VERY simplified version of a time management class. It is, however, the essence of the process. It only works however, if you are absolutely truthful with yourself about how you spend you day’s time and absolutely truthful about what you really want. 

I hear so much about not “ having enough time” to exercise, or to shop for healthy food, or to prepare healthy meals, that I decided to address it head on. 

For those interested in more, there are really so many great resources on the web, from, to books by Harvard Business Review. 

Here is a one page handout on the subject. Click on the title below to download. 

"Time Management" from the Stanford Center for Teaching and Learning

For extra credit, here is an awesome self assessment and time management tool from University of Kentucky. Click on the title to download. 


"The Successful Person's Guide to Time Management"

This should be be printed, filled out and used. 

Class is dismissed. Homework is due next week! I’d love to hear how you do. 










Wellness Wednesday: Holiday Wellness Collection 

Here is a little collection of holiday wellness quick reads from my past blog posts. I hope they help the next week or two be merry and bright. 

Holidays, the Happy Disruption

Holiday Wellness

Gratitude is at the Center of Wellness

Look forward to more post collections during the holiday week while I take a little time off from writing and just highlight the “ need to know “ stuff. 

Merry Christmas and Happy New Year. 

May the light of the season be within you. 


Structure Sunday: The Structure of Prevention 

Here’s a simple question: Is it hard or easy to stay well ? 

Staying well is two things: avoiding disease and optimizing health. I’ll be the first to tell you that there are some diseases you simply can’t avoid. I’ll also be the first to tell you that most diseases are a preventable. 

What is prevention ? Is prevention hard or easy ? Prevention is not one thing. It is collection of different actions. Most importantly, these are done over time, on a meaningful schedule, and so we call them habits. I find that lots of people do certain few healthy things once in a while. Oftentimes these same people wonder why they do not see gains in health or fitness. What they are missing is the element of time. Taking one, two or ten habits and performing them in perpetuity over time is what makes the changes. If I could change just a few ideas in my patient’s minds, this would be one of them. 

Prevention requires you to harness the element of time. Time gives your actions power. Most prevention habits are simple easy acts in and of themselves. By themselves they don’t so much. Multiply them by months and they make significant and long lasting changes. 

Here are some super simple acts which you can multiply over time. 


Record three things for which you are grateful before you go to bed. 

Read them upon arising. 

In a conversation, listen first then respond with “I” statements. 

Think and take two full breaths before responding during a conflict. 

Meditate for 10 minutes per day. 

Have about 6 close friends. 

Consider having a partner. 

Have a pet of whom you take good care. 

Ensure your work is meaningful. 

Don’t overspend. 

Take your allotted vacations. 



Wash your hands at work and when you get home. 

Get your required vaccinations. 

Sleep at least 7-8 hours a night. 

Wear seat belts. 

Use sunscreen.

Eat three meals and three snacks each with protein and produce. 

Avoid simple refined carbohydrates. 

Use olive oil and green tea. 

Ban soda, smokes and drugs. 

Limit to one wine or beer per day. 

Drink 3 liters water per day. 

Brush twice a day, floss and use a peroxide mouthwash before bed. 

Exercise for half hour 5-6 times per week combining cardio and light resistance. 

Incorporate yoga every week. 


Super basic, right ?

Super powerful.

That’s what these habits are when repeated over time. 

Prevention doesn’t hurt, it’s not expensive, and you can do it anywhere. It does take a plan to carve out the small slots in the day to do these things, but it really isn’t hard. Just keep the list handy, do the items, and you will wake up in a few months and notice some pleasant changes. 











Wellness Wednesday: Physical Methods

Not uncommonly I have patients with pain issues, mood issues or both. Now, I suppose I write as many prescriptions for these conditions as the average doctor, but such a thing is hard to know. And yet, I am an advocate of what I like to call "physical methods" to control these problems.  

Since I practice evidence based medicine, I am committed to sticking to methods that have evidence supporting them. Believe it or not, the following methods are all evidence based. 

Let’s tackle pain first.

It’s pretty simple. If you have pain when stationery, you need to move. If you have pain when moving, you need to reduce movement or get help to find a better way to move. Physical therapy can provide this. 

Use heat and cold. Heat is to increase circulation which helps tight muscles or cramps. Cold is best for anything inflammatory or injury related in the first 24 hours. 

Massage is helpful in many cases of muscle pain. 

Abdominal binders, support hose, and wrist braces can be helpful in certain circumstances like pregnancy related pain. 

For the open-minded, I advise yoga for all sorts of pain: migraines, rheumatologic conditions like lupus, and for back pain pending approval of the back doctor.

Meditation takes a little more commitment, but it too, is evidence based and has been shown to favorably impact pain. 

Of course actual exercise is well known to improve resilience and to make people more resistant to pain. 

I consider music a physical method. Post operative patients have lower pain medication requirements when exposed to music they consider pleasant. The applications go way beyond that. 

Physical Methods for Mood 

All of the above also improve and stabilize mood. But did you know that the smell of natural citrus elevates the mood ? That’s why we have atomizers for natural essential citrus oils in our office. 

Simple adequate sleep is a proven method to improve the mood and increase the pain threshold. 

And if you haven’t heard this term before, you need to: Hangry. It is the combination of angry and hungry, which pretty much makes the connection between mood and blood sugar. Yes, something as simple as three meals and three snacks rich in protein can improve the mood immensely. 

All of these interventions and their effects are quite measurable and act via the nervous system and the circulatory system. Take the time to incorporate them into your life. They work. They’re cheap, and they’re fun. Because we all need to feel better sometime. 



To learn more see our pages: 




Music and Health

Wellness Wednesday: Curing Procrastination

Is procrastination an illness ? No. But it can affect your health. Let’s take a look at what it is, why it happens, and how to cure it. 

What is procrastination? 

Procrastination is putting off things that need to be done. How big is the problem ? About 20 % of people are chronic procrastinators and these percentages increase significantly during college. People who are chronic procrastinators perform more poorly in their family, in high school, in college, in jobs, and in relationships. This sounds like an unfortunate nuisance, but it is actually a health problem. According to many sources, procrastination creates stress which interferes with sleep, weakens the immune system and makes heart disease more likely. It is also very hard on mental health. 

To understand why procrastination happens, we have to look deeply into issues like self control, self image, inner honesty, fear of failure and distress tolerance. 

1. Procrastination may start as a form of silent rebellion against parents. This becomes a vicious cycle as adolescents avoid parents in favor of friends, who do not hold them accountable as parents would. 

2. Certain necessary tasks or even the idea of the tasks make people uncomfortable (distressed) , either because they dislike doing them or they are perceived as difficult or overwhelming. Those who cope with their feeling of dread or discomfort (distress) by avoidance may procrastinate, only making matters worse. Those who have poor coping skills or distress tolerance are likely to do other dysfunctional things to cope with life’s daily challenges and discomforts, such as abuse substances. 

3. When people do not want to risk failure, they will subconsciously "arrange" to have insufficient time for a task, thereby providing themselves with a ready excuse for their suboptimal performance.

4. Procrastination is self sabotage. People procrastinate to fail in order to show others they have been mistreated, to “get back at them” or to acquire victim status. ( This is, by the way, passive aggressive behavior.) 

5. Some people who procrastinate simply want others to pull up the slack in whatever it is that needs doing. 

6. Some people who really want to succeed procrastinate. They deceive themselves about several things: 

  •      They will be more motivated tomorrow.
  •      They have plenty of time left. 
  •      Their task will not be that challenging nor take that much time. 
  •      They will do better when they are feeing more motivated or inspired. 
  •      They think they do better under pressure. 
  •      They are talented enough to pull it off. 

     These are white lies we tell ourselves. 


What can be done about procrastination ? 


1. Procrastination is hard to overcome but it requires honesty with oneself and usually firm persistent guidance from others. 

2. Strong feelings of interpersonal conflict should be evaluated by a qualified counselor. 

3. Problems with procrastination in the setting of substance abuse should also be evaluated by a qualified counselor. 

4. Simple methods to beat procrastination are as follows: 

  •      Fortify your will power and your distress tolerance with adequate sleep, healthy meals, snacks and regular exercise.      
  •      Become a list maker. Get a system which is either digital, paper or both and include reminders such as sticky notes or alarms. 
  •      Use SMART goals criteria for your list items. See more about SMART goals HERE. Nutshell version: SMART goals are specific,measurable,attainable, relevant and time-bound.
  •      Overestimate the time it will take you to get something done. 
  •      Ditch perfection as a goal. It gets in the way of progress and accomplishment. 
  •      Divide large tasks into a series of small manageable tasks. 
  •      Practice mental “ time travel” to see how you will really feel tomorrow. 

5. All of this requires self regulation. Practicing self regulation with small tasks has been proven to improve self regulation with big tasks. 

  •      Realize that self regulation is critical to healthy relationships and success in life. That should be plenty of motivation. 
  •      Pick several easy small tasks, and stick to them. Larger tasks WILL get easier as a result. 
  •       Yoga or meditation is especially good training for the nervous system where self regulation is concerned. 
  •      Be easy on yourself for lapses. 
  •      Pat yourself on the back for all successes. 




Cal Poly’s Procrastination PDF - WOW amazing document !

Psychology Today:




The Procrastination DOOM LOOP


Procrastination and the great Stanford Marshmallow experiment


University of Cambridge




Procrastination and Your Heart





Wellness Wednesday: Beyond Relaxation to Renewal 

Most of us are familiar with the recommendation to relax on a regular basis. We are all familiar with the ravages of stress and the problems associated with insufficient sleep. We generally think of relaxation as the antidote. To most people this means to physically rest or sleep , and to be quiet and still. There is no doubt that some of this kind of time is good on a daily basis, especially if it is done in a mindful fashion such as in meditation.

But sometimes we need more than relaxation. We need renewal. Renewal goes beyond relaxation. It is similar to relaxation in that it is a break from the usual work routine. However, after that, the similarities end. Renewal is more planned. It may involve physical activity, such as exercise, or an outdoor adventure. It may even involve a challenge. It often involves other people, especially people who are new to you. It involves unfamiliarity, learning and even getting outside of one’s comfort zone. 

Productivity experts are extolling such “ strategic renewal” as the newest productivity tool in the success toolbox. This concept can be utilized on different time schedules: daily, weekly , monthly, quarterly. 

Daily Renewals 

  • exercise 
  • meditation 
  • reading 
  • connect with close family and friends 

Weekend Renewals: 

  • connect with farther flung family and friends, socialize and entertain
  • patronizing the arts 
  • sports 
  • spiritual observance
  • volunteer
  • outdoors 
  • reading 
  • exercise 
  • creative pursuits outside of work 

Monthly or Quarterly renewal: 

  • adventures 
  • conferences 
  • different kinds of work projects 
  • travel

See to the basics first: adequate sleep, regular exercise, and good nutrition. Ensure some relaxation on a daily basis. But go beyond all this and try to start thinking about renewal as well. 

To learn more :

See our sections on Sleep Yoga and Meditation 


Huffington Post 

New York Times 

Stanford University Cafe Science

What Most Successful People Do On the Weekend, by Lauren Vanderkam 

Structure Sunday: The Structure of a Weekend

Did you know the the weekend as we know it is only about 100 years old ? I can't imagine life without the weekend. There is no natural correlate to the 7 day week. It is entirely man made and was probably designed in ancient Babylon. From there it was exported to the ancient Israelites and continued through the Jewish people through the idea of the Sabbath. 


However, it wasn't until 1908 in a car factory owned by Henry Ford, that Jewish and Christian cultures combined to give us the weekend. Before that time, workers would labor untold hours. Early labor rights were established after the French revolution, but even then their workweek was ten days on with one day off. Meanwhile in England, Sunday had evolved into the " Lord's Day" for rest and worship. 

In the late 1800s Europe was becoming more and more hostile to Jews. Immigration of Jews to America increased, and they entered the work force. Accordingly, the work force in Henry Ford's factory was composed of both Christians and Jews. The Christians took Sunday off, and the Jews observed Saturday as the Sabbath. To make everyone happy, the clever and diplomatic Mr. Ford created the two day weekend. Not only that, Mr. Ford popularized the weekend road trip... driving what ? You guessed it, his Model T. 

How did fewer working days effect commerce and productivity ? Somewhat paradoxically, research on the subject consistently shows that fewer work hours lead to greater productivity overall. Some say the sweet spot is a four day 8 hour work week, but that remains to be demonstrated. 



The Atlantic

American Public Media


Here is a rough version of what has been our ideal weekend routine: 


Friday evening: Dinner with family (with reference to the Jewish Sabbath)  something fun afterwards

Saturday morning: Catch up on sleep, brunch with family, outings, projects

Saturday evening: entertain 

Sunday Morning: brunch with family, clean house,  projects

Sunday evening: family dinner and get ready for the week


Here are some fantastic resources on having a great weekend: 


Reader's Digest

The Muse

Fast Company